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The Philippine drug war: A crisis of human rights and HIV

3,000 people have been killed in drug-related crackdowns. This hard-line stance threatens to derail the HIV response in the Philippines, as harm reduction services face mounting pressure to close.

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Since coming to power in June, 2016, President Rodrigo Duterte has initiated a campaign of institutional and vigilante violence against people who use and deal drugs, instigating a crisis of human rights among people who use drugs and fuelling the HIV epidemic in the Philippines.

The hugely popular Duterte won his presidential campaign by a landslide on the basis that crime, corruption and drug abuse would be squashed. At his swearing in ceremony, he called on the population to kill any drug users they knew, without fear of consequence.

Duterte, the former mayor of the southern city, Davao, publically admitted to being linked to the ‘Davao Death Squad’ – a vigilante, anti-crime group which carried out over 1,000 unlawful killings of supposed criminals and drug offenders, under the protection of the government. His hard-line stance has continued as president, calling on the killing of 100,000 people who use drugs across the country.

Since coming to power, over 3,000 people have been killed in drug-related crack downs – the large majority of these have been extrajudiciary.

In an open letter penned to the United Nations Office on Drugs and Crime (UNODC) in August, over 300 international NGOs called on the UN to take immediate action on the situation in the Philippines. Duterte’s tactics are in direct opposition to the agency mandate to ensure that "all people can live in health, dignity and peace, with security and prosperity."

Ann Fordham, Executive Director of the International Drug Policy Consortium, said: “We are calling on the UN drug control bodies to publicly condemn these atrocities in the Philippines. This senseless killing cannot be justified as a drug control measure… their silence is unacceptable, while people are being killed on the streets day after day.” The UNODC has since released a statement expressing its concern over the situation in the country.

The crackdown on illicit drug use has had a severe effect on the HIV response in the Philippines, a country which the World Health Organization (WHO) says has one of the fastest growing HIV epidemics in the world, with numbers of new infections increasing dramatically in recent years.

In the Philippines most recent country progress report to UNAIDS, it states that in 2000, only one new case every three days was diagnosed. By 2013, this had increased to one new case every two hours. Up until 2008, the large majority of new infections in the Philippines were the result of heterosexual transmission, but this also has changed dramatically in recent years, with men who have sex with men and people who inject drugs making up the large majority of new infections.

Duterte’s war on drugs has practically eliminated the ability for civil society and public health authorities to provide harm reduction services to those who need them most. Nowhere is this more felt than in Cebu, Philippines second city and centre of the country’s injecting drug use epidemic.

Cebu began distributing clean needles to drug users in 1993, continuing until 2009, when the practice was halted by city officials. In a special report by the Thomas Reuters Foundation, Dr Ilya Tac-an from the Cebu City Health Department said: "The following year prevalence of HIV amongst people who inject drugs went from less than 0.5% to 53%."

From 2009 to 2015, needle exchange programmes were given the green-light intermittently, until pressure from anti-drug groups and politicians put an end to their delivery. But as Dr Tac-an explained: "The needle and syringe programme was one [way] of getting them [injecting drug users] to come in for the other services, we are not really reaching that many injecting drug users [now]."

Others who had originally supplied clean needles and syringes feel unable to do so now. Jerson See from HIV organisation Cebu Plus says he no longer distributes clean needles, after learning his organisation was under government watch. He hopes that they will “reconsider the harm reduction programme because it is also a way of halting the spread of HIV."

A social worker living in the city told Thomas Reuters Foundation that he was “called by Manila” and told to stop distributing needles to drug users.

The UN has widely condemned the actions of the Philippine government. In a statement prior to the inauguration of Duterte, UN Secretary General Ban Ki Moon said: “I unequivocally condemn his apparent endorsement of extrajudicial killings, which is illegal and a breach of fundamental rights and freedoms.”

The UN Special Rapporteur on the right to health, Dainius Puras said: “Concerning drug-dependency, this should be treated as a public health issue and justice systems that decriminalise drug consumption and possession for personal use as a means to improve health outcomes.”